Depressive Episode (depressive + episode)

Distribution by Scientific Domains

Kinds of Depressive Episode

  • major depressive episode

  • Selected Abstracts


    Annmarie Cano
    Many couples seeking therapy report the occurrence of severe, negative marital stressors (e.g., infidelity, threats of marital dissolution). In addition, existing research has demonstrated that these marital stressors precipitate Major Depressive Episodes and psychological symptoms. This longitudinal study examines the antecedents and consequencs of negative marital stressors to help clinicians and researchers develop interventions that might prevent these stressors and their outcomes. Forty-one women completed a semistructured interview and measures of marital discord and depressive symptoms within one month after experiencing a marital stressor (baseline) and at a 16-month follow-up. The results indicate taht baseline marital discord contributes to the occurrence of additional marital stressors during the follow-up period. Although baseline depressive symptoms do not predict additional marital stressors, depressive symtoms along with marital discord predict future depressive symptoms. Finally, baseline marital discord and additional marital stressors contribute to future dissolution. Clinical and research implications are discussed. [source]

    Diagnostic utility of the Quick Inventory of Depressive Symptomatology (QIDS-C16 and QIDS-SR16) in the elderly

    P. M. Doraiswamy
    Doraiswamy PM, Bernstein IH, Rush AJ, Kyutoku Y, Carmody TJ, Macleod L, Venkatraman S, Burks M, Stegman D, Witte B, Trivedi MH. Diagnostic utility of the Quick Inventory of Depressive Symptomatology (QIDS-C16 and QIDS-SR16) in the elderly. Objective:, To evaluate psychometric properties and comparability ability of the Montgomery-Åsberg Depression Rating Scale (MADRS) vs. the Quick Inventory of Depressive Symptomatology,Clinician-rated (QIDS-C16) and Self-report (QIDS-SR16) scales to detect a current major depressive episode in the elderly. Method:, Community and clinic subjects (age ,60 years) were administered the Mini-International Neuropsychiatric Interview (MINI) for DSM-IV and three depression scales randomly. Statistics included classical test and Samejima item response theories, factor analyzes, and receiver operating characteristic methods. Results:, In 229 elderly patients (mean age = 73 years, 39% male, 54% current depression), all three scales were unidimensional and with nearly equal Cronbach , reliability (0.85,0.89). Each scale discriminated persons with major depression from the non-depressed, but the QIDS-C16 was slightly more accurate. Conclusion:, All three tests are valid for detecting geriatric major depression with the QIDS-C16 being slightly better. Self-rated QIDS-SR16 is recommended as a screening tool as it is least expensive and least time consuming. [source]

    Validation of the Depression and Somatic Symptoms Scale by comparison with the Short Form 36 scale among psychiatric outpatients with major depressive disorder

    Ching-I Hung M.D.
    Abstract Background: The Depression and Somatic Symptoms Scale (DSSS) is a self-administered scale developed for monitoring both depression and somatic symptoms. The aims of this study were to establish the criterion-related validity of the DSSS by testing the correlation between the DSSS and the Short Form 36 (SF-36) scale and to compare the ability of the DSSS and two other scales in predicting the outcome of the SF-36. Methods: The study enrolled 135 outpatients with a major depressive episode, 95 of whom received treatment for 1 month. Four scales were administered and evaluated: the DSSS, the SF-36, the Hospital Anxiety and Depression Scale, and the Hamilton Depression Rating Scale. Pearson correlation was used to test correlations among scales. Multiple linear regressions were used to find the scales most effective in predicting the SF-36. Results: The three scales were significantly correlated with most of the SF-36 subscales. The depression and somatic subscales of the DSSS significantly correlated with the mental and physical subscales of the SF-36, respectively. The DSSS and the Hospital Anxiety and Depression Scale were better able to predict physical and mental subscales of the SF-36, respectively. The Hamilton Depression Rating Scale had a good ability to predict functional impairment. Conclusions: Psychometric scales with appropriate somatic symptoms might be more compatible with both physical and mental dimensions of the SF-36. DSSS proved to be a valid scale for monitoring both depression and somatic symptoms in patients with depression. Future studies should test whether the DSSS is better at predicting the treatment and prognosis of depression than conventional scales for depression. Depression and Anxiety, 2009. © 2009 Wiley-Liss, Inc. [source]

    The effect of depression on quality of life of patients with type II diabetes mellitus

    brahim Eren M.D.
    Abstract Diabetes mellitus (DM) is a frequently encountered metabolic disease with chronic features and involves numerous complications throughout its course, which causes severe restriction and disability in an individual's life. It has been reported that the incidence of depression is higher in diabetic patients and that diabetes is one of the risk factors in the development of depression. It has also been reported that co-morbid psychiatric disorders cause further deterioration in the quality of life in diabetic patients. The aim of this study was to investigate the effects of depression on the quality of life in type II DM patients. Sixty patients (30 females and 30 males) with current major depressive episode diagnosed according to DSM-IV criteria, and 48 type II DM patients (30 females and 18 males) without a major depressive episode (non-depressed group) were included in the study. All patients were evaluated with a semi-structured interview form to assess the clinical features of DM, Hamilton Rating Scale for Anxiety (HRSA), Hamilton Rating Scale for Depression (HRSD), and the Turkish version of The World Health Organization Quality of Life Assessment-Brief (WHOQOL-BREF). The HRSD and HRSA scores in the depressed group were 24.87±4.83 and 21.07±5.44, respectively, whereas those in the non-depressed group were 7.83±3.92 and 6.88±3.43, respectively. The physical health, psychological health, social relationship, environmental and social pressure domain, general health-related quality of life, overall quality of life, and WHOQOL-BREF total scores were found significantly lower in the depressed group than the non-depressed group. There were significant negative correlations between HRSD and HRSA scores and physical health, psychological health, social relationship, environmental and social pressure domain, general health-related quality of life, overall quality of life, and WHOQOL-BREF total scores. Furthermore, there were significant negative correlations between the HbA1c level and physical health, social relationship, environmental domain, social pressure domain, general health-related quality of life, overall quality of life, and WHOQOL-BREF total scores. However, there was a significant positive correlation between the level of education and physical health, psychological health, social relationship, environmental social pressure domain, overall quality of life, and WHOQOL-BREF total scores. There were significant negative correlations between social relationship domain score, and age and duration of illness. Our study demonstrates that the presence of depression in type II DM further deteriorates the quality of life of the patients. Since treating depression would have a beneficial effect on the quality of life, clinicians should carefully assess for depression associated with type II DM. Depression and Anxiety 0:1,9, 2007. © 2007 Wiley-Liss, Inc. [source]

    Screening for depression and anxiety disorders in primary care patients

    Adomas Bunevicius B.S.
    Abstract Mood and anxiety disorders are highly prevalent in primary health care. In this study we assessed performance of the Hospital Anxiety and Depression Scale (HADS) for screening of depression and anxiety disorders in a population of primary care patients. A total of 503 primary care patients consecutively admitted to the primary care medical center in Kaunas, Lithuania, completed the study. We found that the HADS subscale of depression (HADS-D) at a cutoff score of 6 or more showed the best performance screening for a major depressive episode diagnosed by means of the Mini International Neuropsychiatric Interview (MINI), with a sensitivity of 80%, specificity of 69%, positive predictive value of 80%, negative predictive value of 92%, and area under the receiver operating characteristic (ROC) curve of 0.75. Performance of the HADS-D against MINI diagnosis of dysthymia was weak. The HADS subscale of anxiety (HADS-A) at a cutoff score of 9 or more showed the best performance screening for MINI diagnosis of overall anxiety disorders, with a sensitivity of 77%, specificity of 75%, positive predictive value of 53%, negative predictive value of 90%, and area under the ROC curve of 0.76. These results suggest that in primary care patients HADS is an adequate screening instrument for the MINI diagnoses of major depressive episode, but not for dysthymia at a cutoff score of 6, and for anxiety disorders at a cutoff score of 9. Depression and Anxiety 24:455,460, 2007. © 2006 Wiley-Liss, Inc. [source]

    Panic Disorder Severity Scale: Reliability and validity of the Turkish version,,

    E. Serap Monkul M.D.
    Abstract We assessed the reliability and validity of the Turkish version of the seven-item Panic Disorder Severity Scale (PDSS). We recruited 174 subjects, including 104 with current DSM-IV panic disorder with (n = 76) or without(n = 28)agoraphobia, 14 with a major depressive episode, 24 with a non-panic anxiety disorder, and 32 healthy controls. Assessment instruments were Panic Disorder Severity Scale, Panic and Agoraphobia Scale, both the observer-rated (P&Ao) and self-rating (P&Asr); Clinical Global Impression Scale (CGI); Hamilton Anxiety Scale, and Beck Depression Inventory. We repeated the measures for a group of panic disorder patients (n = 51) after 4 weeks to assess test,retest reliability. The internal consistency (Cronbach's ,) of the PDSS was .92,94. The inter-rater correlation coefficient was .79. The test,retest correlation coefficient after 4 weeks was .63. In discriminant validity analyses, the highest correlation for PDSS was with P&Ao, P&Asr (r=.87 and .87, respectively) and CGI (r=.76) and the lowest with Beck Depression Inventory (r=.29). The cut-off point was six/seven, associated with high sensitivity (99%) and specificity (98%). This study confirmed the objectivity, reliability and validity of the Turkish version of the PDSS. Depression and Anxiety 00:000,000, 2004. © 2004 Wiley-Liss, Inc. [source]

    Nonresponse to first-line pharmacotherapy may predict relapse and recurrence of remitted geriatric depression

    Alastair J. Flint MB, FRANZCP, FRCP(C)
    Abstract The authors examined whether nonresponse to first-line pharmacotherapy was associated with an increased probability of relapse or recurrence following remission of an episode of geriatric depression. The study group consisted of 74 elderly patients whose index episode of nonpsychotic unipolar major depression had responded to antidepressant pharmacotherapy. In 6 of these patients, the depressive episode had not responded to first-line pharmacotherapy (8 weeks of nortriptyline, including 2 weeks of adjunctive lithium) but it had responded to second-line treatment (phenelzine with or without adjunctive lithium). The 74 patients were maintained on acute doses of the medications that had led to response and were followed for 2 years or until relapse or recurrence, whichever occurred first. The cumulative probability of relapse or recurrence was 67% for patients who responded to second-line treatment compared with 18% for patients who responded to first-line treatment (P=0.0003). As expected, mean time to response was significantly longer for patients who responded to second-line treatment but this factor did not account for the difference in out-come between the two groups. These findings suggest that pharmacotherapy resistance may constitute a risk factor for relapse or recurrence of remitted geriatric depression, even when patients are maintained on the medication that they eventually respond to. Depression and Anxiety 13:125,131, 2001. © 2001 Wiley-Liss, Inc. [source]

    Indicators of pretreatment suicidal ideation in adults with major depressive disorder

    D. W. Morris
    Morris DW, Trivedi MH, Husain MM, Fava M, Budhwar N, Wisniewski SR, Miyahara S, Gollan JK, Davis LL, Daly EJ, Rush AJ. Indicators of pretreatment suicidal ideation in adults with major depressive disorder. Objective:, In order to evaluate the presence of treatment emergent suicidal ideation (SI), it becomes necessary to identify those patients with SI at the onset of treatment. The purpose of this report is to identify sociodemographic and clinical features that are associated with SI in major depressive disorder (MDD) patients prior to treatment with a selective serotonin reuptake inhibitor. Method:, This multisite study enrolled 265 out-patients with non-psychotic MDD. Sociodemographic and clinical features of participants with and without SI were compared post hoc. Results:, Social phobia, bulimia nervosa, number of past depressive episodes, and race were independently associated with SI by one or more SI measure. Conclusion:, Concurrent social phobia and bulimia nervosa may be potential risk factors for SI in patients with non-psychotic MDD. Additionally, patients with more than one past depressive episode may also be at increased risk of SI. [source]

    Venlafaxine monotherapy in bipolar type II depressed patients unresponsive to prior lithium monotherapy

    J. D. Amsterdam
    Amsterdam JD, Wang G, Shults J. Venlafaxine monotherapy in bipolar type II depressed patients unresponsive to prior lithium monotherapy. Objective:, We examine the safety and efficacy of venlafaxine monotherapy in bipolar type II (BP II) patients with major depressive episode (MDE) who were unresponsive to prior lithium monotherapy. We hypothesized that venlafaxine would be superior to lithium with a low hypomanic conversion rate. Method:, Seventeen patients who were unresponsive to prior lithium monotherapy were crossed to venlafaxine monotherapy for 12 weeks. The primary outcome was within-subject change in total Hamilton Depression Rating (HAM-D) score over time. Secondary outcomes included the change in Young Mania Rating (YMRS) and clinical global impressions severity (CGI/S) and change (CGI/C) scores. Results:, Venlafaxine produced significantly greater reductions in HAM-D (P < 0.0005), CGI/S (P < 0.0005), and CGI/C (P < 0.0005) scores vs. prior lithium. There was no difference in mean YMRS scores between treatment conditions (P = 0.179). Conclusion:, Venlafaxine monotherapy may be a safe and effective monotherapy of BP II MDE with a low hypomanic conversion rate in lithium non-responders. [source]

    Depressive relapse during lithium treatment associated with increased serum thyroid-stimulating hormone: results from two placebo-controlled bipolar I maintenance studies

    M. A. Frye
    Objective:, To assess the relationship between depressive relapse and change in thyroid function in an exploratory post hoc analysis from a controlled maintenance evaluation of bipolar I disorder. Method:, Mean thyroid-stimulating hormone (TSH) and outcome data were pooled from two 18-month, double-blind, placebo-controlled, maintenance studies of lamotrigine and lithium monotherapy. A post hoc analysis of 109 subjects (n = 55 lamotrigine, n = 32 lithium, n = 22 placebo) with serum TSH values at screening and either week 52 (±14 days) or study drop-out was conducted. Results:, Lithium-treated subjects who required an intervention for a depressive episode had a significantly higher adjusted mean TSH level (4.4 ,IU/ml) compared with lithium-treated subjects who did not require intervention for a depressive episode (2.4 ,IU/ml). Conclusion:, Lithium-related changes in thyroid function are clinically relevant and should be carefully monitored in the maintenance phase of bipolar disorder to maximize mood stability and minimize the risk of subsyndromal or syndromal depressive relapse. [source]

    Outcome of late-life depression after 3 years of sequential treatment

    R. M. Kok
    Objective:, To study the outcome of a sequential treatment protocol in elderly, severely depressed in-patients. Method:, All 81 patients from a 12-week double-blind randomized controlled trial (RCT) comparing venlafaxine with nortriptyline were asked to participate in a 3 year follow-up study. Thirty-two patients who did not achieve remission during the RCT, entered an open sequential treatment protocol and were treated with augmentation with lithium, switch to a monoamine oxidase inhibitor or ECT. Results:, Seventy-eight of the 81 patients (96.3%) achieved a response [,50% reduction in Montgomery Åsberg Depression Rating Scale score) and 68 patients (84%) a complete remission (final MADRS score , 10) within 3 years of treatment. Greater severity and longer duration of the depressive episode at baseline predicted poor recovery. Augmentation with lithium may be the best treatment option in treatment resistant depressed elderly. Only few patients dropped-out due to side-effects. Conclusion:, Our study demonstrates the importance of persisting with antidepressant treatment in elderly patients who do not respond to the first or second treatment. [source]

    Postpartum depression without delivering a child?

    G. Manfredi
    Objective:, Depression in people related to delivering women is documented in their mates, but only anecdotal in other family members. We describe a case of depression in a woman who had previously experienced postpartum depression after the birth of her nephew. Method:, A clinical description of the case. Results:, A 53-year-old woman, hysterectomized at age 47 years, was admitted for attempted suicide. She developed major depressive episode 1 month after her daughter had delivered a son. She had a past history of two postpartum depressive episodes clinically identical to the current episode. The episode resolved after 5 weeks. At 1-year follow-up, the patient is still asymptomatic. Conclusion:, Psychological and cultural factors were at play in this case more than hormonal and biopsychosocial ones. [source]

    CADASIL: underdiagnosed in psychiatric patients?

    T. Leyhe
    Objective:, Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is exclusively related to symptoms of the central nervous system. Retrospectively in up to 15% the initial presentation is psychiatric disturbances. In these cases the diagnosis often is delayed or missed. Method:, Two cases of CADASIL diagnosed in a psychiatric hospital are presented. Results:, Both patients were admitted to the gerontopsychiatric department (one because of a suicidal attempt and a depressive episode, the other because of cognitive decline and progressive personal neglect). Brain magnetic resonance imaging (MRI) showed severe leukoencephalopathy in the absence of cardiovascular risk factors. In both cases, diagnosis of CADASIL was made by the identification of specific granular osmiophilic material in skin biopsies. Conclusion:, Brain MRI should be performed in all cases of late onset of severe psychiatric symptoms. CADASIL should be considered as a possible differential diagnosis whenever a marked leukoencephalopathy is detectable. Diagnosis can be verified by taking a skin biopsy or by specific genetic testing. [source]

    Subtypes of major depression in substance dependence

    ADDICTION, Issue 10 2009
    Mark J. Niciu
    ABSTRACT Aims This study evaluated features that differentiate subtypes of major depressive episode (MDE) in the context of substance dependence (SD). Design Secondary data analysis using pooled data from family-based and case,control genetic studies of SD. Setting Community recruitment through academic medical centers. Participants A total of 1929 unrelated subjects with alcohol and/or drug dependence. Measurements Demographics, diagnostic criteria for psychiatric and substance use disorders and related clinical features were obtained using the Semi-Structured Assessment for Drug Dependence and Alcoholism. We compared four groups: no life-time MDE (no MDE), independent MDE only (I-MDE), substance-induced MDE only (SI-MDE) and both types of MDE. Findings Psychiatric measures were better predictors of MDE subtype than substance-related or socio-demographic ones. Subjects with both types of MDE reported more life-time depressive symptoms and comorbid anxiety disorders and were more likely to have attempted suicide than subjects with I-MDE or SI-MDE. Subjects with both types of MDE, like those with I-MDE, were also more likely than subjects with SI-MDE to be alcohol-dependent only than either drug-dependent only or both alcohol- and drug-dependent. Conclusions SD individuals with both types of MDE have greater psychiatric severity than those with I-MDE only or SI-MDE only. These and other features that distinguish among the MDE subtypes have important diagnostic and potential therapeutic implications. [source]

    Oxidative stress parameters after combined fluoxetine and acetylsalicylic acid therapy in depressive patients

    Piotr Ga, ecki
    Abstract Objective There are numerous reports indicating disturbed equilibrium between oxidative processes and antioxidative defense in patients with depression. Moreover, depressive patients are characterized by the presence of elements of an inflammatory process, which is one of the sources of reactive oxygen species (ROS). In view of the above, it was decided to study both the effect of fluoxetine monotherapy and that of fluoxetine co-administered with acetylsalicylic acid on lipid peroxidation and antioxidative defense in patients with the first depressive episode in their life. Method Seventy seven patients with major depressive disorder (MDD), divided into two groups were included in the study. The first group, consisting of 52 patients, received fluoxetine 20 mg, and the second one, in addition to fluoxetine 20 mg, received 150 mg of acetylsalicylic acid. The activity of antioxidative enzymes, copper-zinc superoxide dismutase (CuZnSOD, SOD1), catalase (CAT), glutathione peroxidase (GPSH-x) and the concentration of malonyldialdehyde (MDA) was determined in erythrocytes, whereas the total antioxidant status (TAS) was determined in the plasma. All parameters were measured before and after three month therapy. Results The obtained results indicate a significant decrease in the activity of SOD1, CAT and GSHP-x, as well as in MDA concentration after the combined therapy. Also a significant TAS increase was observed after the combined therapy. The study demonstrated that combined therapy with fluoxetine and ASA is characterized by the same efficacy and clinical safety as fluoxetine monotherapy, resulting additionally in improvement of oxidative stress parameters in the patients treated for depression. Copyright © 2009 John Wiley & Sons, Ltd. [source]

    An integration of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa: A case study using the case formulation method

    Peter S. Hendricks MA
    Abstract Objective The current study provides an illustration of an integration of cognitive-behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for the treatment of bulimia nervosa (BN), based on the case formulation strategy. Method A 25-year-old Hispanic female referred herself for the treatment of eating difficulties and depressed mood. Diagnostic criteria were met for BN, major depressive episode, and alcohol abuse. Components of both CBT and IPT were utilized throughout the course of treatment. Results CBT techniques appeared to be most effective in eliminating binge eating and binge drinking behavior, whereas IPT techniques seemed to be most effective in reducing purging behavior. Results revealed that the client was no longer experiencing clinically significant symptoms of BN, depression, or alcohol abuse at end of treatment and follow-up (18 months after treatment onset). Discussion Findings support the integration of CBT and IPT for the treatment of BN and, potentially, other eating disorders. © 2005 by Wiley Periodicals, Inc. [source]

    Differences in diagnostic subtypes among patients with late and early onset of a single depressive episode

    Lars Vedel Kessing
    Abstract Objective It is unclear whether patients with late onset and patients with early onset present with different subtypes of depression. The aim of the study was to compare the prevalence of subtypes of ICD-10 single depressive episodes for patients with late onset (age >65 years) and patient with early onset (age,,,65 years) in a nationwide sample of all patients discharged from psychiatric in- or outpatient settings. Method All patients who got a diagnosis of a single depressive episode in a period from 1994,2002 at the end of the first outpatient treatment or at the first discharge from psychiatric hospitalisation ever in Denmark were identified in a nationwide register. Results In total, 18.192 patients were given a diagnosis of a single depressive episode at the first outpatient contact and 8.396 patients were given a diagnosis of a single depressive episode at the first psychiatric hospitalisation ever. Patients with late onset were more often women, more often presented with a severe depressive episode and more often with psychosis than patients with early onset, in both inpatient and outpatient treatment settings. No differences were found between patients with late and patients with early onset in the prevalence of depression with or without melancholic symptoms,in either of the treatment settings. Conclusions Patients with a late onset first depressive episode are more often women and are clinically characterised by more severe depressions and a higher prevalence of psychosis than patients with early onset. Copyright © 2006 John Wiley & Sons, Ltd. [source]

    The structure of common mental disorders: A replication study in a community sample of adolescents and young adults

    Katja Beesdo-baum
    Abstract Previous research suggests that patterns of comorbidity of common mental disorders among adults are best reflected by a hierarchical three-factor structure with two correlated factors (,anxious-misery' and ,fear') summarized in a second-order ,internalizing' factor and one ,externalizing' factor. This three-factor structure has not been examined yet in a sample of adolescents and young adults. A representative sample of 3021 adolescents and young adults (baseline age 14,24) were prospectively followed over 10 years. Mental disorders were assessed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) by using the standardized Munich Composite International Diagnostic Interview. Ten mental disorders (major depressive episode, dysthymia, generalized anxiety disorder, social phobia, specific phobia, agoraphobia, panic disorder, alcohol dependence, drug dependence, antisocial personality) were fitted to a series of Confirmatory Factor Analysis models using: (1) 12-month data, and (2) lifetime data from a person-year data set. The three-factor model showed good fit to the observed data in our sample both when 12-month diagnoses and lifetime-to-date diagnoses from a person-year data file were used; yet the higher-order ,internalizing' factor summarizing ,anxious misery' and ,fear' had to be omitted. The three-factor model could be replicated in a sample of adolescents and young adults with the exception that the second-order ,internalizing' factor was not consistent with the data. Further research is necessary to provide more complete insight into the structure of mental disorders by examining the stability of the structure of mental disorders in different developmental stages (ages) and by using a more extensive set of mental disorders. Copyright © 2009 John Wiley & Sons, Ltd. [source]

    Lessons learned from the clinical reappraisal study of the Composite International Diagnostic Interview with Latinos

    Margarita Alegria
    Abstract Given recent adaptations of the World Health Organization's World Mental Health Composite International Diagnostic Interview (WMH-CIDI), new methodological studies are needed to evaluate the concordance of CIDI diagnoses with clinical diagnostic interviews. This paper summarizes lessons learned from a clinical reappraisal study done with US Latinos. We compare CIDI diagnoses with independent clinical diagnosis using the World Mental Health Structured Clinical Interview for DSM-IV (WMH-SCID 2000). Three sub-samples stratified by diagnostic status (CIDI positive, CIDI negative, or CIDI sub-threshold for a disorder) based on nine disorders were randomly selected for a telephone re-interview using the SCID. We calculated sensitivity, specificity, and weight-adjusted Cohen's kappa. Weighted 12 month prevalence estimates of the SCID are slightly higher than those of the CIDI for generalized anxiety disorder, alcohol abuse/dependence, and drug abuse/dependence. For Latinos, CIDI-SCID concordance at the aggregate disorder level is comparable, albeit lower, to other published reports. The CIDI does very well identifying negative cases and classifying disorders at the aggregate level. Good concordance was also found for major depressive episode and panic disorder. Yet, our data suggests that the CIDI presents problems for assessing post-traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD). Recommendations on how to improve future versions of the CIDI for Latinos are offered. Copyright © 2009 John Wiley & Sons, Ltd. [source]

    Onset of Depression in Elderly Persons After Hip Fracture: Implications for Prevention and Early Intervention of Late-Life Depression

    Eric J. Lenze MD
    OBJECTIVES: To identify predictors of onset of major depressive disorder (MDD) and of depressive symptoms in subjects who suffered a hip fracture. DESIGN: Prospective naturalistic study. SETTING: University of Pittsburgh Medical Center,Shadyside, a large urban hospital in Pittsburgh, Pennsylvannia. PARTICIPANTS: One hundred twenty-six elderly patients who received surgical fixation for hip fracture and who were not experiencing a major depressive episode at the time of the fracture; severely cognitively impaired persons were excluded. MEASUREMENTS: Subjects were evaluated at the time of hospital discharge using a battery of clinical measures (including apathy measured using the Apathy Evaluation Scale (AES), delirium, cognitive measures, social support, and disability level). Depression was assessed at the end of the surgical stay, 2 weeks later, and then monthly for 6 months, using the Hamilton Rating Scale for Depression (Ham-D) to evaluate symptomatology and the Primary Care Evaluation of Mental Disorders to evaluate diagnosis of MDD. RESULTS: Eighteen of 126 subjects (14.3%) developed MDD after hip fracture. Of these, 11 developed MDD by the end of the hospitalization, and seven developed MDD between 2 and 10 weeks later. Logistic regression showed that baseline apathy score, as measured using the AES, was the only clinical measure associated with the development of MDD (odds ratio=1.09, 95% confidence interval=1.03,1.16, P=.003); 46.2% of those with high AES scores developed MDD, versus 10.9% of those with lower scores. In contrast, cognitive variables, delirium, disability after hip fracture, and other factors related to the fracture (e.g., fracture type) were not associated with MDD. A repeated-measures analysis with Ham-D over time as a dependent variable generally confirmed these findings; depressive symptoms were highest immediately after the fracture, and apathy and delirium scores were associated with higher depressive symptom levels. CONCLUSION: The onset of MDD is common after hip fracture, and the greatest period of risk is immediately after the fracture. Individuals with clinical evidence of apathy are at high risk for developing MDD, and evaluation and close follow-up of such individuals is warranted. However, further research is needed to examine other candidate variables (e.g., clinical measures or biomarkers) to model adequately the risk for MDD after hip fracture and other disabling medical events. [source]

    Meditation with yoga, group therapy with hypnosis, and psychoeducation for long-term depressed mood: a randomized pilot trial

    Lisa D. Butler
    Abstract This randomized pilot study investigated the effects of meditation with yoga (and psychoeducation) versus group therapy with hypnosis (and psychoeducation) versus psychoeducation alone on diagnostic status and symptom levels among 46 individuals with long-term depressive disorders. Results indicate that significantly more meditation group participants experienced a remission than did controls at 9-month follow-up. Eight hypnosis group participants also experienced a remission, but the difference from controls was not statistically significant. Three control participants, but no meditation or hypnosis participants, developed a new depressive episode during the study, though this difference did not reach statistical significance in any case. Although all groups reported some reduction in symptom levels, they did not differ significantly in that outcome. Overall, these results suggest that these two interventions show promise for treating low- to moderate-level depression. © 2008 Wiley Periodicals, Inc. J Clin Psychol 64(7): 1,15, 2008. [source]

    A case illustration of resistance from a cognitive perspective

    Cory F. Newman
    Brian, a 36-year-old, single, white male, entered cognitive therapy in response to a depressive episode precipitated by the loss of a job. In addition to his Major Depression, the client met diagnostic criteria for Dysthymia and Personality Disorder Not Otherwise Specified. The first three sessions focused on Brian's unemployment crisis and related dysphoria, as well as his passive-avoidant approach to life. Brian collaborated with the therapist in formulating a treatment plan and quickly found a new job, whereupon he abruptly withdrew from therapy. Shortly thereafter, Brian contacted the therapist in a renewed state of "crisis" and returned for a fourth session. The therapist attempted to draw a link between Brian's passive-avoidant style and his vulnerability to problems such as those he currently was experiencing. The client had difficulty understanding the therapist's thread of logic, became somewhat defensive and combative, and did not return for further sessions. © 2002 John Wiley & Sons, Inc. J Clin Psychol/In Session 58: 145,149, 2002. [source]

    Mental Disorders, Comorbidity, and Postrunaway Arrests Among Homeless and Runaway Adolescents

    Xiaojin Chen
    This study examined the associations between lifetime mental disorder, comorbidity, and self-reported postrunaway arrests among 428 (187 males, 241 females) homeless and runaway youth. The analysis examined the pattern of arrests across five lifetime mental disorders (alcohol abuse, drug abuse, conduct disorder, major depressive episode, and posttraumatic stress disorder). The adolescents, ranging from 16 to 19 years old, were interviewed directly on the streets and in shelters in four Midwestern states using computer-assisted personal interviewing. Extensive self-reports of early life history, behaviors since running away from home, and diagnostic interviewing (UM-CIDI and DISC-R) were used to estimate possible disorders. There was a high level of postrunaway arrests reported by the youth; more than half were arrested at least once after the initial runaway, with the average of 4.4 times. Consistent with the hypotheses, there were differential associations between individual mental disorders and involvement with the criminal justice system. Only externalizing disorders such as substance abuse and conduct disorder were related to arrest. Street youth with multiple externalizing and internalizing disorders were more likely to be arrested than nondisordered youths. [source]

    Striatal dopamine transporter imaging correlates with depressive symptoms and tower of London task performance in Parkinson's disease

    MOVEMENT DISORDERS, Issue 11 2008
    Irena Rektorova MD
    Abstract We studied whether the 123I-FP-CIT uptake in the striatum correlates with depressive symptoms and cognitive performance in patients with Parkinson's disease (PD). Twenty patients with PD without major depression and/or dementia (mean age 61.7 ± 12.7 years) underwent the 123I-FP-CIT SPECT. Depressive symptoms and cognitive performance were assessed in the ON state. The ratios of striatal to occipital binding for the entire striatum, putamina, and putamen to the caudate (put/caud) index were calculated in the basal ganglia. The association between neuropsychiatric measures and dopamine transporter (DAT) availability was calculated; multiple regression analysis was used to assess association with age and disease duration. We found significant correlations between Montgomery and Asberg Depression Rating Scale (MARDS) and Tower of London (TOL) task scores and 123I-FP-CIT uptake in various striatal ROIs. Multiple regression analysis confirmed the significant relationship between TOL performance and put/caud ratio (P = 0.001) and to age (P = 0.001), and between MADRS and left striatal (P = 0.005) and putaminal DAT availability (P = 0.003). Our pilot study results demonstrate that imaging with 123I-FP-CIT SPECT appears to be sensitive for detecting dopaminergic deficit associated with mild depressive symptoms and specific cognitive dysfunction in patients with PD, yet without a current depressive episode and/or dementia. © 2008 Movement Disorder Society [source]

    Improvement of cognitive functioning in mood disorder patients with depressive symptomatic recovery during treatment: An exploratory analysis

    Abstract, Depressive symptoms have a large impact on cognitive test performance of mood disorder patients. After remission, some improvement of cognitive functioning has been observed, but also stable deficits have been reported both during depression and remission. In the present study, the authors aimed to investigate the cognitive functioning of mood disorder patients in relation to early symptomatic recovery, by comparing performances at the Wechsler Adult Intelligence Scale-Revised (WAIS-R) of responders and non-responders to the antidepressant treatment. The sample was composed of 51 hospitalized patients for a major depressive episode (major depressives/bipolars = 37/14). All patients were treated with fluvoxamine and evaluated at baseline and after 4 weeks using the 21-item Hamilton Rating Scale for Depression. All subjects were once assessed for their cognitive functioning with the WAIS-R, at the end of the fourth week of treatment. In the current sample, patients who showed a significant symptomatic remission after 4 weeks of treatment showed higher total WAIS-R scores and a lower incidence of cognitive impairment, compared to non-responders to treatment. No major differences could be observed on any particular subtest, but rather a global improving of scores in responders compared to non-responders to pharmacotherapy. Pre-treatment illness severity, that was significantly higher among non-responders, was significantly associated with patients' intelligence quotient scores. Despite a number of limitations, present data support a strong effect of depressive symptoms on patients WAIS-R performances and an early global improvement of cognitive functioning concurrent with symptomathology recovery during pharmacological treatment. [source]

    Unipolar depression with racing thoughts: A bipolar spectrum disorder?

    Abstract Major depressive disorder (MDD) with racing/crowded thoughts is understudied. Kraepelin classified ,depression with flight of ideas' in the mixed states of his manic-depressive insanity. The aim of the study was to test whether MDD with racing/crowded thoughts was close to bipolar disorders. Consecutive 379 bipolar-II disorder (BP-II) and 271 MDD depressed outpatients were interviewed using the Structured Clinical Interview for DSM-IV, the Hypomania Interview Guide, and the Family History Screen, by a senior psychiatrist in a private practice. Intra-depression hypomanic symptoms were systematically assessed. Mixed depression was defined as a major depressive episode (MDE) plus three or more intra-MDE hypomanic symptoms. MDD with racing/crowded thoughts was compared to MDD without racing/crowded thoughts on classic bipolar validators (young onset age, many recurrences, atypical and mixed depression, bipolar family history). Frequency of MDD with racing/crowded thoughts was 56.4%. MDD with racing/crowded thoughts, versus MDD without racing/crowded thoughts, had significantly lower age at onset, more MDE severity, more psychotic, melancholic, atypical, and mixed depressions, and more bipolar family history. Of the intra-MDE hypomanic symptoms, irritability, psychomotor agitation and distractibility were significantly more common in MDD with racing/crowded thoughts. Compared to BP-II on bipolar validators, validators were less common in MDD with racing/crowded thoughts. MDD with racing/crowded thoughts seemed to be a severe variant of MDD. MDD with racing/crowded thoughts versus MDD without racing/crowded thoughts, and versus BP-II, had significant differences on bipolar validators, suggesting that it may lie along a continuum linking MDD without racing/crowded thoughts and BP-II. [source]

    The management of bipolar disorder in primary care: A review of existing and emerging therapies

    MICHAEL BERK mbbch, ff (psych), franzcp, mmed (psych)
    Abstract, Recent evidence suggests that the prevalence of bipolar disorder is as much as fivefold higher than previously believed, and may amount to nearly 5% of the population, making it almost as common as unipolar major depression. It is, therefore, not unrealistic to assume that primary care or family physicians will frequently encounter bipolar patients in their practice. Such patients may present with a depressive episode, for a variety of medical reasons, for longer-term maintenance after stabilization, and even with an acute manic episode. Whatever the reason, a working knowledge of current trends in the acute and longer-term management of bipolar disorder would be helpful to the primary care physician. In addition, an understanding of important side-effects and drug interactions that occur with drugs used to treat bipolar disorder, which may be encountered in the medical setting, are paramount. This paper will attempt to review existing and emerging therapies in bipolar disorder, as well as their common drug interactions and side-effects. [source]

    Intra-episode hypomanic symptoms during major depression and their correlates

    Abstract Recent studies have shown that 40,50% of major depressive disorders (MDD) may become bipolar with time. Intra-episode hypomanic symptoms in MDD may be a first step in this shift. The purpose of the present study was to find factors associated with intra-episode hypomanic symptoms in MDD. Two hundred and forty-three consecutive MDD outpatients were interviewed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV), Clinician Version (SCID-CV), as modified by Benazzi and Akiskal (J. Affect. Disord. 2003; 73: 33,38). History of hypomania and presence of hypomanic symptoms during major depressive episode (MDE) were systematically assessed. Intra-episode hypomanic symptoms were defined as an MDE combined with three or more hypomanic symptoms, following Akiskal and Benazzi (J. Affect. Disord. 2003; 73: 113,122). Major depressive disorder with intra-episode hypomanic symptoms (MDD + H) was compared to MDD without hypomanic symptoms on classic bipolar validators. It was found that MDD + H (usually irritability, distractibility, racing thoughts, psychomotor agitation, and more talkativeness) was present in 32.5% of patients. Patients with MDD + H versus MDD had significantly lower age at onset, more atypical depressions, and more bipolar family history. Recurrences were not significantly different. Multivariate logistic regression found that bipolar family history and atypical depression were significantly and independently associated with MDD + H. Findings suggest that MDD + H may be associated with a bipolar vulnerability. Duration of illness and recurrences do not seem to be important for the onset of MDD + H. Bipolar genetic vulnerability seems to be required for onset of intra-episode hypomanic symptoms in MDD. Intra-episode hypomanic symptoms might be the first step of a process leading to the switch of MDD to bipolar disorders. Predicting the switch might have important treatment implications, because antidepressants used alone may worsen the course of bipolar disorders. Prospective studies are required to support these findings and hypotheses. [source]

    Emanuel Miller Lecture: Early onset depressions , meanings, mechanisms and processes

    Ian M. Goodyer
    Background:, Depressive syndromes in children and adolescents constitute a serious group of mental disorders with considerable risk for recurrence. A more precise understanding of aetiology is necessary to improve treatment and management. Methods:, Three neuroactive agents are purported to be involved in the aetiology of these disorders: serotonin, brain-derived neurotrophic factor and cortisol. A literature review was conducted to determine their contributions to the emergence of unipolar depressions in the adolescent years. Results:, Serotonin, brain-derived neurotrophic factor and cortisol may operate in concert within two distinct functional frameworks: atypical early epigenesis arising in the first few years of life and resulting in the formation of a vulnerable neuronal network involving in particular the amygdala and ventral prefrontal cortex. Individuals with this vulnerability are likely to show impaired mood regulation when faced with environmental demands during adolescence and over the subsequent decades; and acquired neuroendangerment, a pathological brain process leading to reduced synaptic plasticity, in particular in the hippocampus and perhaps the nucleus accumbens and ventral tegmentum. This may result in motivational, cognitive and behavioural deficits at any point in the lifespan most apparent at times of environmental demand. Conclusions:, The characteristics, course and outcome of a depressive episode may depend on the extent of the involvement of both atypical early neurogenesis and acquired neuroendangerment. [source]

    Modifying interpretation and imagination in clinical depression: A single case series using cognitive bias modification

    Simon E. Blackwell
    The current cognitive bias modification (CBM) paradigm targets interpretation bias (CBM-I) in depression via promoting positive imagery. We investigated the impact of repeated sessions of this CBM-I on interpretation bias, mood and mental health in participants currently experiencing a major depressive episode. Seven participants completed daily sessions of CBM-I at home for one week in a single case series. Outcome measures were completed pre and post a one-week baseline period, and after the week of daily CBM-I. Depressive symptoms were also assessed at a 2-week follow-up. Four of seven participants demonstrated improvements in mood, bias and/or mental health after one week of CBM-I, with improvements in depressive symptoms maintained at follow-up. Discussion of the remaining three highlights difficulties involved in translating CBM-I interventions from the laboratory to the clinic. To bridge this gap, we suggest that it is critical to examine the failures as well as the successes. Copyright © 2010 John Wiley & Sons, Ltd. [source]